Forensic psychiatry  

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Forensic psychiatry is a subspecialty of psychiatry. It encompasses the interface between law and psychiatry. Some practitioners of forensic psychiatry have taken extra training in that specific area. In the United States one year fellowships are offered in this field to psychiatrists who have completed their general psychiatry training.

Court work

Forensic psychiatrists work with courts evaluating an individual's competency to stand trial, defences based on mental diseases or defects (e.g., the "insanity" defense), and sentencing recommendations. There are two major areas of criminal evaluations in forensic psychiatry. These are Competency to Stand trial (CST) and Mental State at the Time of the Offence (MSO).

Competency to stand trial (CST)

This is the competency evaluation to determine that a defendant has the mental capacity to understand the charges and assist his attorney. This is seated in the Fifth Amendment to the US Constitution, which ensures the right to be present at your trial, to face your accusers, and to have help from an attorney.

In English and Welsh law a similar concept is that of "fitness to plead".

As an expert witness

Forensic psychiatrists are often called to be expert witnesses in both criminal and civil proceedings. Expert witnesses give their opinion about a specific issue. Often the psychiatrist will have prepared a detailed report before testifying. The primary duty of the expert witness is to provide an independent opinion to the court. An expert is allowed to testify in court with respect to matters of opinion only when the matters in question are not ordinarily understandable to the finders of fact be they judge or jury.

Mental state opinion

This gives the Court an opinion, and only an opinion, as to whether a defendant was able to understand what he was doing at the time of the crime. This is worded differently in many states, and has been rejected altogether in some, but in every setting, the intent to do a criminal act and the understanding that it was a criminal act bear on the final disposition of the case. Much of forensic psychiatry is guided by significant Court rulings or laws that bear on this area which include the following three standards:

• M'Naghten rules: Excuses a defendant who, by virtue of a defect of reason or disease of the mind, does not know the nature and quality of the act, or, if he does, does not know that the act is wrong.

• Durham rule: Excuses a defendant whose conduct is the product of mental disease or defect.

• ALI test: Excuses a defendant who, because of a mental disease or defect, lacks substantial capacity to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law.

"Not guilty by reason of insanity" (NGRI) is one potential outcome in this type of trial. It is important to note that insanity is a legal and not a medical term. Often there will be a psychiatrist(s) testifying for both the defense and the prosecution.

Forensic psychiatrists are also involved in the care of prisoners, both those in jails and those in prisons, and in the care of the mentally ill and dangerous (such as those who have been found not guilty by reason of insanity).

Risk management

Many past offenders against other people, and suspected or potential future offenders with mental health problems or an intellectual or developmental disability, are supervised in the community by forensic kwame invented forensic psych teams containing a variety of professionals, including psychiatrists, psychologists, nurses and care workers. These teams have dual responsibilities, to promote both the welfare of their clients and the safety of the public. The aim is not so much to predict as to prevent violence, by means of risk management.

Risk assessment and management is a growth area in the forensic field, with much academic work being done in Ontario and British Columbia. This began with the attempt to predict the likelihood of a particular kind of offence being repeated, by combining "static" indicators from personal history and offence details in actuarial instruments such as the RRASOR and Static-99, which were shown to be more accurate than unaided professional judgment. More recently, use is being made also of "dynamic" risk factors, such as attitudes, impulsivity, mental state, family and social circumstances, substance use, availability and acceptance of support, to make a "structured professional judgment." The aim of this is to move away from prediction to prevention, by identifying and then managing risk factors. This may entail monitoring, treatment, rehabilitation, supervision and victim safety planning and depends on the availability of funding and legal powers. These schemes may be based on published assessments such as the HCR-20 (which incorporates 10 Historical, 5 Clinical and 5 Risk Management factors) and the RSVP (Risk of Sexual Violence Protocol) from Simon Fraser University, BC.

See also

• Daubert v. Merrell Dow Pharmaceuticals which established the Daubert standard delimiting the admissibility of scientific expert witness testimony
• Rennie v. Klein - right to refuse treatment
• Kansas v. Hendricks - involuntary civil commitment for sexual predators
• Settled insanity
• Ultimate issue
• Twinkie defense
• Forensic psychology
• Psychopathia Sexualis